{
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"OrgName": "MARK T LOPEZ OD PC",
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"FirstLineMailingAddress": "1026 LONG COVE RD",
"SecondLineMailingAddress": "P.O. BOX 336",
"MailingAddressCityName": "GALES FERRY",
"MailingAddressStateName": "CT",
"MailingAddressPostalCode": "06335-1812",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "860-464-6060",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1026 LONG COVE RD",
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"PracticeLocationAddressCityName": "GALES FERRY",
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"PracticeLocationAddressTelephoneNumber": "860-464-6060",
"PracticeLocationAddressFaxNumber": "860-464-7013",
"EnumerationDate": "03/26/2008",
"LastUpdateDate": "02/04/2011",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LOPEZ",
"AuthorizedOfficialFirstName": "MARK",
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"AuthorizedOfficialTitle": "DOCTOR",
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"AuthorizedOfficialTelephoneNumber": "860-464-6060",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Optometrist",
"LicenseNumber": "CT856",
"LicenseNumberStateCode": "CT",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}